Midterm- gestational diabetes

Question 1

DM maternal risk of PG

Answer 1

• acceleration of end-organ damage
• increased risk of developing diabetic ketoacidosis
• increased risk of hypoglycemic rxns

Question 2

DM risk to fetus

Answer 2

• hyperglycemia and hyperinsulinemia in fetus
• spontaneous abortion (up to 35% risk)
• congenital anomalies (8-12% without preconception counseling)
• stillbirth
• IUGR
• macrosomia
• prematurity
• neonatal hypoglycemia
• respiratory distress syndrome (delayed pulmonary maturation)

Question 3

management of DM PG?

Answer 3

perinatologists manage them - considered high risk

Question 4

definition of gestational diabetes

Answer 4

diabetes developed during the second half of pregnancy
inability to balance blood glucose levels in the face of insulin resistance in pregnancy
no incr in congenital malformations

Question 5

if a woman has gestational diabetes when should her blood sugar levels return to normal after pregnancy?

Answer 5

6 day after delivery

Question 6

pathophysiology of glucose balance in normal pregnancy?

Answer 6

• Increased maternal insulin resistance at cellular level due to normal increases of hPL, progesterone, cortisol and estrogen
• Increased availability of maternal glucose for fetal use
• hPL increases maternal lipolysis providing FFA, alternative fuel substrates for mother

Question 7

pathophysiology of patient with gestational diabetes

Answer 7

-Pre-existing insulin resistance:
Elevated insulin levels
BMI, family  history, quality of diet
-Low pancreatic secretion of insulin:
Depressed insulin levels
More often lean patients

Question 8

more than ____ % of patients who exhibit an abnormal OGTT lack any risk facotrs

Answer 8

50%

that’s why screening is so necessary

Question 9

what are risk factors for developing gestational diabetes?

Answer 9

maternal age >30 yo
previous baby > 9 lb
prior fetal or neonatal death
prematurity
congenital anomalies
maternal HTN
excessive maternal weight gain
maternal obesity
FHx of DM

Question 10

If patient is at increased risk of gestational diabetes, test at

Answer 10

first prenatal visit

if normal, repeat at 24-28 wks

Question 11

If patient doesn’t meet risks for gestational diabetes, screen at

Answer 11

24-28 wks

Question 12

*Glucose screening test (GST)

procedure*

Answer 12

at least 2 hours away from a meal

• eat a normal meal
• 2 hours later, drink 50 gm glucose drink
• plasma glucose drawn 1 hour later
• nothing by mouth except water until after blood draw

Question 13

cutoff for GST?

Answer 13

if GST >140 mg/dL, oral glucose tolerance test (OGTT) recommended
if GST >190 mg/dL, consider checking fasting glucose instead of OGTT

Question 14

diagnostic testing

Answer 14

oral glucose tolerance test (OGTT)

aka 2 or 3 hour OGTT

Question 15

OGTT protocol

Answer 15

Fast overnight (at least 8 hours)
Fasting blood glucose drawn
Drink 100 gm glucose drink (nothing else by mouth other than water until testing finished)
1 hour, 2 hour and/or 3 hour blood glucose drawn

Question 16

diagnosis of gestational diabetes with at least 2 of 4 values exceeding upper limit

Answer 16

Fasting >95 mg/dL
1 hour >180 mg/dL
2 hour >155 mg/dL
3 hour >140 mg/dL

Question 17

dipstick glucosuria

Answer 17

done at every prenatal

not appropriate for monitoring or diagnosing GD (because what and when they ate will affect the results)

Question 18

random blood glucose

Answer 18

just a snapshot

used to follow up 2 episodes of glucosuria

Question 19

home glucometer monitoring

Answer 19

used to follow blood glucose levels of patients with diagnosed GD
Useful for patients to get objective feedback on dietary choices

Question 20

ketone urine sticks

Answer 20

tells you they are metabolizing fats, normal if irregular meals, AbN with regular meals

Question 21

Indications for referral for oral hypoglycemic medication or exogenous insulin

Answer 21

Fasting > 95 mg/dL
1 hr post prandial >130-140 mg/dL
2 hr post prandial >120 mg/dL

Question 22

diet recommendations

Answer 22

• no refined carbohydrates (sugar of any kind, dried fruit, processed grain) -> fruit ok if they eat the whole piece and with protein
• limit- breads, pastas, rice, potatoes, high glycemic fruits and veggies (ex: banana)
• always eat carbs with protein and fat
• high fiber (slows release of sugar from gut)

Question 23

what’s a botanical medicine that could be used for GD?

Answer 23

gymnema sylvester (bitter melon)

Question 24

supplement for GD?

Answer 24

chromium (enhances insulin’s effect by binding to cell membranes and decreasing insulin resistance)

Question 25

maternal short term sequelae of GD?

Answer 25

• preeclampsia (4X)
• infections including pyelonephritis and postpartum endometritis
• pelvic injury due to fetal macrosomia
• cesarean birth due to increased fetal distress and dystocia
• cardio-respiratory symptoms due to polyhydramnios
• Increased risk of post-partum hemorrhage
• 5-10% of women with gestational diabetes will develop type 2 diabeteis

Question 26

short term fetal/neonatal sequelae of class A1 diabetic mothers

Answer 26

Birth injuries due to macrosomia
Hypoglycemia in neonatal period
Hypoxemia in-utero
Hyperbilirubinemia